Treatment of Bilateral Hip Fractures in Patients with Multiple Injuries

S.E. Guriev, P.V. Tanasienko, V.V. Vasilov, F.Yu. Fil

Abstract

Introduction. Damage to the musculoskeletal system in multiple traumas occurs in 80–90 % of cases, in 10–15 % of victims they are leading and define life prognosis [2]. Out of injuries of the locomotor system, hip fractures are one of the most significant and life-threatening, their treatment is difficult. The severity of these injuries, difficulties of using conservative methods of treatment for multiple and combined fractures, frequent development of complications when using standard methods of osteosynthesis often lead to unsatisfactory results [4]. In this regard, the search continues for the optimal treatment of bilateral hip fractures in patients with polytrauma. The aim of our study was to determine the optimal methods of surgical treatment of bilateral hip fractures in patients with multiple injuries. Materials and methods. To perform our study, we analyzed the data of 75 patients with bilateral fractures of the hip and polytrauma, who were treated at the Kyiv Municipal Clinical Emergency Hospital between 2006 and 2015. There were 59 men (78.7 %) and 26 women (21.3 %). The average age of victims was 38.2 ± 1.1 years. Results. On admission to the hospital, diagnosis of bilateral hip fractures was carried out, with subsequent stabilization of vital functions. Bilateral hip fractures were found in 48 (64.0 %) of the victims. One open and the other — closed fractures were observed in 16 (21.3 %) of patients. Both open fractures were diagnosed in 11 (14.7 %) of the victims. After stabilization of patient’s state, we have conducted replacement of external fixation device (EFD), plaster splints and skeletal extension by internal fixation in different ways depending on the type and location of fractures, as well as taking into account the general condition of patients. Reasons for changing the method were the development of contractures in adjacent joints, inappropriate position of fracture fragments in EFD, the risk of inflammation around the rods and the possibility of infection of bone or soft tissues. 13 (17.3 %) patients had two supracondylar or transcondylar fractures (33 А 1–3, С 1–3). These individuals underwent extramedullary minimally invasive osteosynthesis using plates with angular stability (locking compression plates — LCP). In 23 (30.7 %) patients, we have detected a combination of distal and diaphyseal femur fractures. For the treatment of these patients, a combination approach was used: at the first stage, diaphyseal fracture was fixed with the help of intramedullary nailing, and the second stage was the fixation of distal fracture using minimally invasive external osteosynthesis with LCP. Conclusions. At the early hospital stage, when treating bilateral hip fractures in polytrauma, it is necessary to stabilize fractures using EFD that makes it possible to anesthetize, to reduce the fracture and to mobilize the patient. At the hospital stage of treatment, there is a need to change the method by internal fixation according to indications, depending on the location and type of a fracture, with the aim of final reposition, stable fixation and mobilization of adjacent joints. Using an integrated differentiated approach to the treatment of bilateral hip fractures in patients with polytrauma made it possible to obtain positive outcomes in 94.6 % of cases.